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Article
Literature Review
Methods of Hair Removal
- March 1999
- Journal of the American Academy of Dermatology 40(2 Pt 1):143-55; quiz 156-7
- Source
- PubMed
Abstract
The methods of hair removal vary between simple inexpensive means of home treatment (shaving, plucking, depilatories) to expensive and potentially time-consuming means used by paraprofessionals, nurses, and/or physicians (electrolysis, lasers, x-ray). The ways in which these different methods induce hair removal, the duration of such removal, and the nuances between devices within the same category of methods are discussed. (J Am Acad Dermatol 1999;40:143-55.) Learning objective: At the completion of this learning activity, participants should be cognizant of the different control mechanisms for hair growth and how the different means of hair removal affect these. Readers will also become familiar with the different types of electrolysis and lasers currently used for hair removal and the advantages and disadvantages of each.
... O bulbo capilar está na base do folículo, onde se encontra em contato com a papila dérmica e contém o cromóforo de melanina. Mulheres com cabelos escuros têm maiores quantidades de melanina e, portanto, melhores resultados na depilação com LIP [8]. ...
... Uma redução mais eficaz na quantidade de pelos, através da terapia com LIP, é conseguida quando os folículos pilosos encontram-se na fase anágena. Em geral, são necessários intervalos de 4 semanas entre os tratamentos para se obter os melhores resultados, pois em média, esse é o tempo necessário para que os pelos entrem na fase anágena [8]. ...
... Os melhores resultados ocorrem no pelo escuro e curto, em pele clara. Os resultados podem durar 12 meses ou mais [8,37]. Apesar da semelhante ação desses dois métodos existem algumas diferenças importantes, que estão listadas na tabela I. Em geral, os resultados da remoção de pelos são parecidos em ambos os dispositivos, mas a terapia com LIP ganhou mais popularidade por causa de seu custo relativamente mais baixo e pelo menor desconforto nas sessões [37]. ...
Os dispositivos de luz intensa pulsada promovem o princípio básico de absorção de fótons por cromóforos endógenos ou exógenos encontrados na pele. A luz pulsada é convertida em energia calorífica, a qual coagula o alvo desejado (foto-termólise seletiva). Essa tecnologia envolve um sistema de lâmpadas paralelas de xenônio e capacitores contidos, que é aplicada diretamente à superfície da pele. Seu espectro de emissão varia de 500 a 1300 nm, apresentando assim, uma grande versatilidade de tratamentos. Para a construção deste artigo de revisão, a metodologia adotada foi uma pesquisa bibliográfica em revistas científicas da área de saúde indexadas no Pubmed (entre os anos de 1989 a 2010) que abordam os efeitos terapêuticos e fisiológicos da terapia de luz intensa pulsada. Dentre os efeitos terapêuticos aplicados à terapia com luz intensa pulsada, destacamos a remoção de pelos, tratamento de lesões pigmentadas, lesões vasculares, acnes, e rejuvenescimento da pele. Uma das maiores vantagens dos dispositivos de luz intensa pulsada é em relação à sua versatilidade e a economia. Esses dispositivos são mais vantajosos devido a sua capacidade em tratar grandes áreas de pele. No entanto, mais ensaios controlados comparativos com um período de acompanhamento estendido são necessários para determinar diferenças significativas da LIP e outras terapias.Palavras-chave: luz intensa pulsada, efeitos fisiológicos, efeitos terapêuticos.
... The duration of the anagen phase determines hair length [40]. There is substantial variation in anagen duration according to body region: up to 6 years in scalp, 1 to 3 months in arms, 4 to 6 months in legs, and 1 to 2 months in thighs [44]. Approximately 85% to 90% of all scalp hair is in the anagen stage at any given moment [40]. ...
... The lower portion of the hair follicle regresses as part of a process that involves programmed deletion of matrix and ORS cells [40,46]. After regression, the hair follicle goes through a resting phase (telogen), which lasts 2 to 4 months on the human scalp; 2 and a 6 half months in the chest; 2 to 4 months in the arms; and 3 to 6 months in the legs [44]. The follicle remains at this stage until it is reactivated by intra-and extrafollicular signals [40]. ...
Background:
Hirsutism is defined as the presence of terminal hair with male distribution in women, and polycystic ovary syndrome (PCOS) is the most common etiology of hirsutism.
Methods:
The aim of this study is to review aspects of hair growth that are relevant for the understanding of hirsutism in PCOS, along with current treatment alternatives.
Results:
The prevalence of hirsutism in PCOS ranges from 70 to 80%, vs. 4% to 11% in women in the general population. Hirsutism in PCOS is associated with both ovarian-derived androgen excess and individual sensitivity of the pilosebaceous unit to androgens. Interventions to decrease hirsutism in PCOS include the suppression of androgen excess by combined oral contraceptives (OCPs). If OCPs are contraindicated, mainly in the presence of insulin-resistance related comorbidities, a second-line option for reducing androgen secretion may be metformin associated with lifestyle changes. Other interventions should be guided by hirsutism severity, determined by the modified Ferriman-Gallwey score, and by the amount of distress hirsutism causes to the patient, and should be maintained for at least 6-12 months. Mild hirsutism is usually treated with a combination of non-pharmacological methods and OCPs, whereas moderate and severe hirsutism may require a combination of antiandrogens and OCPs, or, if OCPs cannot be used, antiandrogens plus a safe contraceptive method. In all cases, strong clinical support is crucial to ensure treatment adherence and success.
Conclusion:
The understanding of the pathophysiology of hirsutism in PCOS, as well as classifying its severity and the distress it causes to each patient is essential to choose the proper treatment. The presence of metabolic comorbidities and menstrual disturbances will also guide the individualized management of hirsutism in women with PCOS.
... Changes of life styles, fashion (e.g., the popularization of bikinis), and movements of freedom in sexuality may have influenced the traditional methods. Development of new technologies such as lasers or home-use depilatory devices has also changed the traditional trends and practices [2,3].A recent study showed that, pubic hair grooming practices are in a diverse range in United States [4]. In the Middle East, removal of the female body hair has been considered for proper hygiene, tradition for many centuries and recommended by Islam [ (5]. ...
... epilation devices are simple to apply and inexpensive methods for home use. The other hair removal methods such as lasers, photoepilation (IPL) and electrolysis are usually more expensive and potentially time-consuming methods used by paraprofessionals, nurses, and/or physicians [2,3]. ...
Aim. Pubic hair removal has been common since the ancient times. In the Middle East, removal of the female pubic hair has been considered as a tradition of hygiene for many centuries, and it is recommended by Islam. However, development of new technologies such as lasers or home-use depilatory devices may have changed the trends and methods. Although pubic hair removal is known to be very common, there is very few data about the pubic hair removal features of the women in eastern Mediterranean area and Islamic population. The aim of this study is to evaluate the recent trends, demographic, social, and sexual features of pubic hair removal activities among Turkish Cypriot women in North Cyprus. Methods. This study was conducted as a cross-sectional study. Self-administered questionnaires were given to volunteered female subjects applied to our outpatient services. Results. The results of our study revealed that a vast majority of Turkish Cypriot women applies regular pubic hair removal and the most common method is waxing. Initialization of pubic hair removal is at the age of menarche and the source of knowledge is the mother. Conclusion. the reasons of pubic hair removal were mostly feeling comfortable, and prevention of odor rather than sexual image or religious reasons.
... Shaving (either with a metal blade or an electric razor) is a rapid and simple procedure for the removal of hair in the pubic area of women; however, the skin texture of the scrotum is not readily amenable for this intervention. Similarly, epilation (by plucking or waxing) is also commonly used by women to remove genital hair; yet this method of hair removal is unlikely to be successfully utilized to treat scrotal hypertrichosis [18]. ...
... An irritant dermatitis may develop at the location of application; therefore, the depilatory should first be applied to a test site (such as the arm) to ensure that this adverse event does not occur. Albeit uncommon, some individuals may experience an allergic contact dermatitis to the thioglycolate [18]. Permanent hair removal may be achieved with electrolysis, lasers, or intense pulsed light devices. ...
Genital rejuvenation is applicable not only to women (vaginal rejuvenation) but also to men (scrotal rejuvenation). There is an increased awareness, reflected by the number of published medical papers, of vaginal rejuvenation; however, rejuvenation of the scrotum has not received similar attention in the medical literature. Scrotal rejuvenation includes treatment of hair-associated scrotal changes (alopecia and hypertrichosis), morphology-associated scrotal changes (wrinkling and laxity), and vascular-associated scrotal changes (angiokeratomas). Rejuvenation of the scrotum potentially may utilize medical therapy, such as topical minoxidil and oral finasteride, for scrotal alopecia and conservative modalities, such as depilatories and electrolysis, for scrotal hypertrichosis. Lasers and energy-based devices may be efficacious for scrotal hypertrichosis and scrotal angiokeratomas. Surgical intervention is the mainstay of therapy for scrotal laxity; however, absorbable suspension sutures are postulated as a potential intervention to provide an adequate scrotal lift. Hair transplantation for scrotal alopecia and injection of botulinum toxin into the dartos muscle for scrotal wrinkling are hypothesized as possible treatments for these conditions. The interest in scrotal rejuvenation is likely to increase as men and their physicians become aware of both the conditions of the scrotum that may warrant rejuvenation and the potential treatments of the scrotum for these individuals.
... But the downside of the medical treatment is that, it works just as long as it is given and also it does not attend to the unwanted hairs over the non androgen-dependent sites. 3 There are many number of temporary depilatory methods like shaving, waxing, depilatory creams and tweezing to name a few. Though these are convenient and inexpensive, they come with their own share of disadvantages like requiring high maintenance and causing folliculitis and irritation. ...
... Pulse durations vary in the millisecond domain. A single or multiple pulse (2)(3)(4)(5), with various pulse delay intervals, can be chosen. The wide choice of wavelengths, pulse duration and delay intervals make the device potentially effective for a wide range of skin types. ...
p class="abstract"> Background: Hirsutism can represent a severe cosmetic disturbance, sometimes with psychological implications. Various lasers and broadband light sources have been developed for treatment of hirsutism. The objective of this study was to know the efficacy of IPL in hirsutism patients
Methods: Forty patients were included in the study. Treatment parameters in respect of pulse duration and fluence were determined according to manufacturer’s recommendation. Hair removal efficiency was calculated as a percentage of the number of hairs present at each visit compared with baseline count.
Results: Most of the patients were of the skin type 4 and type 5. More number of patients had hair growth over the chin and sides. Among 40 patients, 70% of patients had good response and 15% of patients had an excellent response. Minimal side effects only noted.
Conclusions: IPL is safe and efficient modality for treatment of hirsutism.</p
... Drawbacks of these techniques include pain, limitation as regards hair length, skin irritation, wounds and so on [1]- [3]. Removal of hair using laser technology which has become very popular is argued by various studies to be the most efficient method [1], [3]- [6]. This technique is basically the photothermal destruction of hair follicles with red and near-infrared wavelengths suitable for targeting follicular and hair shaft melanin using any of these laser sources; normal mode ruby laser (694 nm), normal mode alexandrite laser (755 nm), pulsed diode lasers (800, 810 nm), long-pulse Nd:YAG laser (1,064 nm), and intense pulsed light (IPL) sources (590-1,200 nm) [1]. ...
... [11][12][13][14] This method not only provides optimal hair removal results but also prevents burnt hair. 15,16 The assessment of the quantitative result of hair removal cannot depend solely on the appearance of the target area before and after the procedure. Several patent applications for computer-assisted image analysis devices for use in evaluating hair growth have been published since the 1990s. ...
Objective:
We aimed to develop and validate a novel computer-assisted automated hair counting system for the quantitative evaluation of laser hair removal (LHR).
Methods:
We developed a computer-aided image processing system to count hairs on shaved skin and validated its performance through clinical trials. Five volunteers of Fitzpatrick skin type III-IV volunteered and were tested on both thighs. The system automatically detects hair and places a "+" sign on each hair site for every positive detection. This method allows clinicians to check whether a hair has been counted or not. We analyzed the difference in the hair counts between the proposed system (automatic) and those by human observers (manual).
Results:
The hair counts from the proposed system and the manual counts were compared. The percentage error between automatic and manual counting was <5% in each subject. The data of the two groups were statistically verified with Student's independent t-test. The averages were statistically equivalent between the two groups. The proposed system showed significant time saving in terms of counting.
Conclusions:
A dependable, accurate, and fast method of counting hairs on shaved skin through a computer-aided image processing system was developed and validated. The "+" signs on the image to indicate detection allows clinicians to compare with the original image and detect any omission or redundancy. The proposed system is expected to be reliable in analyzing the results of multiple skin-related treatments, including LHR and hair transplantation. Further, it is expected to be widely applicable for use in the clinic.
... Depilatory products utilize thioglycolates to disrupt disulfide bonds found in hair follicles, effectively "melting" the hair. [1] These bonds are also found in the epidermal skin layer, so while hair is the primary target, the skin may also be affected. Moreover, these products use sodium hydroxide (NaOH) or calcium hydroxide (CaOH) to raise the working pH of the product, which increases the efficacy of the thioglycolate but also increases the risk of chemical burn. ...
Objective: The objective was to study and describe the presenting patient characteristics for those with chemical burns acquired from hair removal beauty products.
Methods: Retrospective single-center chart review was done to identify all burn injuries caused by the use of depilatory cream use.
Results: A total of seven patients who acquired burn injuries due to depilatory cream use were identified. Six were female and one was male. Patients' age ranged from 3 to 43 years, with a mean age of 27.2 years. Total body surface area of the burns ranged from 0.18% to 0.79% including first- and second-degree burns; none of the patients acquired third-degree burns. Most of the injuries involved groin and pubic area. All patients were treated with wound care, and none required inpatient care. All of the patients who presented to follow-up visits showed re-epithelialization and good healing.
Conclusion: Depilatory cream is a corrosive chemical hair removal agent that can lead to unintended chemical burns if used improperly. Burn-care provider, as well as other health-care providers, should be aware of this unusual cause of chemical burn and educate their patients appropriately.
... Commonly, these include tweezing, shaving, waxing, and bleaching, with around 20% of women using one of these temporary methods at least once a week. 3,4 Hair removal with laser and intense pulsed light has been a part of dermatological practice for the past 20 years and is today one of the most frequently performed cosmetic procedures. 5 Several professional high-power laser and IPL systems are available, and the clinical efficacy is substantially documented in the literature, 6 although its effectiveness can be variable, 7 with only 50-90% of hairs being permanently removed. ...
Laser hair removal has become an accepted form of long-term hair reduction and is now one of the most common dermatologic procedures. Trichoscan is a validated method of assessing hair length, thickness, and density and growth rate using dermoscopy.
The study aimed to evaluate the trichoscopic changes during treatment of hirsutism with 1064-nm neodymium:yttrium-aluminum-garnet laser.
Seventy patients with idiopathic facial hirsutism referring to the laser centers of Al-Azhar University hospital (Asyut and Cairo) between December 2012 and October 2014 were enrolled in this open-label, multicentric study. All participants received six sessions of 1064-nm Nd:YAG laser at 4-week intervals. Mean hair density/cm(2) , percentage of terminal/vellus hair ratio, and hair thickness (mm) were assessed at baseline and 1 month after each session for six sessions using trichoscan.
Seventy female patients completed the study protocol. At the final visit, mean hair density, terminal/vellus hair ratio, and hair thickness were significantly decreased from baseline (73.7 + 20.6, 72.5 + 14.7, 0.095 + 0.02, respectively) to (19.4 + 5.6, 21.3 + 5.2, 0.02 ± 0.007, respectively) (P < 0.05 for each).
One thousand and sixty-four-nm Nd:YAG laser is an effective and safe method in the reduction of unwanted facial hair. Trichoscan is an easy and more accurate method in monitoring the treatment of hair disorders.
© 2015 Wiley Periodicals, Inc.
... Variable scalp hair growth rates (ranging 300-450 lm day À1 , i.e. 0.9 to 1.3 cm/month), different durations of the anagen phase (a few months/body hairs to several years/head hairs), different pigmentation/colour are the three major factors that govern the diversity in the appearance of terminal hairs. With regard body hairs, since the pioneering work of Trotter [16], further studies helped to understand how these hairs show large differences with terminal hairs in length, thickness, etc. [17][18][19][20][21][22][23]. These in fact show a high growth rate, a short anagen period (i.e. ...
Objective
To determine, in vivo, the density, growth rate and percentage of anagen phase follicles of body hairs present on 5 different skin sites (axilla, cheek, chin, leg, upper‐lip) of women and men from 4 different ethnics (African, Caucasian, Chinese, North‐African). The same characteristics of terminal hairs from the nape of all subjects were recorded as references.
Methods
The photo‐trichogram technique was used on all skin sites (of different sizes) at variable times (2 or 3 days) post shaving of small skin areas (a few cm²). Digital photographs were then analysed through a dedicated software that allows to record the density of body hairs (N.cm⁻²), the % of growing hairs (Anagen phase) and their growth rates (in μm/day).
Results
The densities of terminal hairs (on nape) found on all subjects were similar to those previously observed on much larger populations. The same ranking of a decreased density of body hairs in the 5 skin sites was observed in men, irrespective with ethnics. Body hairs seem homogeneously distributed among ethnics on armpit and leg with slight gender‐related differences. In men, a significantly higher anagen phase percentage (> 85%) is found on terminal hairs, cheek and upper‐lip region in Caucasians and North Africans, as compared to African and Chinese men. The technique used cannot precisely determine the very thin hairs present on the faces of all women. The anagen phase percentage appears higher in all women on leg and armpit. Hair body growth rates ranged from 180 to 485 μm/day and were found, on axilla, close to those of terminal hairs.
Conclusion
The abundance of body hairs, in the studied skin sites, appears similar, irrespective with ethnic groups, whereas their functional characteristics (anagen ratio, growth rate) are more driven by individual/gender influences.
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... Cooling devices (contact windows, cold spray, and forced air) are needed to spare the epidermis and superficial dermis. The most common devices used for LHR are the ruby (694 nm), alexandrite (755 nm), diode (800-810 nm), Nd:YAG (1,064 nm) as well as the non-laser, broad-spectrum intense pulsed light (IPL) systems (590-1,200 nm) [1,4]. The long-pulse alexandrite laser is in the midrange of the melanin absorbing spectrum and therefore represents as an optimal choice to target the hair follicle [5], especially in lighter skin types I-III [1]. ...
Background and objectives:
Laser hair removal is the most common laser therapy and the third most commonly performed procedure with more than one million treatments in United States in 2016. This retrospective study was conducted to assess long-term efficacy and safety of the 755 nm laser for hair removal.
Study design/materials and methods:
Nearly, 3,606 laser treatments were performed with the long-pulsed 755 nm wavelength laser equipped with an epidermal cooling device between 1997 and 2005 and were followed till 2013. Standardized assessments were conducted by two treating physicians and patients at two follow-up intervals. At first follow-up, clearance was assessed by two physicians and clearance and satisfaction by patients. At the second follow-up, patients were assessed if hair clearance sustained compared with the first follow-up.
Results:
Nine hundred and forty-eight patients with Fitzpatrick skin types I-IV were treated with a total of 3,606 laser treatments in this study. The mean age at the beginning of the study was 35 years (±11), 95.1% of patients were female (n = 902) and 4.9% male (n = 46). Five hundred and seventy-four patients received a minimum of three treatments and an average of 5.31 (3-16) treatments on axilla, back, bikini, breast, abdomen, face, lower extremity, or upper extremity region. First, follow-up was conducted 3.9 (±1.5) years after the final laser treatment. Seventy-four percent of these patients received 75-100% clearance as reported by the physician and 48% clearance as reported by the patient. Fifty-two percent of patients reported slower hair growth and 42% change in hair texture. Ninety percent of patients treated on axilla, 82% treated on the bikini area, and 79% treated on lower extremities experienced 75% or more clearance after three treatments. Facial, as well as breast and abdomen treatments, only showed a 66% and 62%, respectively, after three treatments. For these locations, five and more treatments were needed to achieve a quote of 79% (face) or 80% (breast and abdomen) for a 75-100% clearance. Upper extremity and back treatments did not have enough physician ratings to draw conclusions. Long-term adverse events were minimal and were all located on the face (one patient scar, four patients herpes infection). Second follow-up of 173 patients was conducted after 11.5 years (±2.0) and 87.9% of patients reported that their improvement sustained.
Conclusions:
The long-pulsed 755 nm alexandrite laser is a safe and efficacious treatment for the reduction of unwanted body hair with permanent results and high patient satisfaction. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
... 17 Also, repetitive epilation may permanently harm the matrix, 13,16 the portion of the hair that grows actively 18 and contains the follicular stem cells. 19 This damage to the matrix is in part explained by the removal of the stimulus-responsive cells. 16 In addition to epilation itself, the actual practice involves the use of a variety of tools and invasive methods, such as using hand-or machine-made forceps, burning the eyelash with hot coals, cutting or pulling the eyelash with fingers, 5 or using sticky tree resin to pluck the lash, as observed in the Amazon region. ...
Purpose:
To evaluate the association of epilation before surgery on the surgical outcome in trachomatous trichiasis (TT) patients.
Methods:
As a secondary data analysis, 1452 patients enrolled in the STAR trial were categorized according to preoperative epilation status. The main outcome was recurrent trichiasis after surgery. We used multivariable analysis, time-to-event analysis, and Cox proportional hazards model.
Results:
Those who epilated prior to surgery tended to be older and female, with worse entropion at baseline. The proportion with postoperative trichiasis was 7.7%, 8.8% in those who epilated versus 5.3% in those who did not (P = 0.03). Adjusting for age and sex, the risk of postoperative TT with epilation was 1.71 (P value = 0.02). Although entropion may be in the biological pathway from epilation to postoperative TT, we adjusted for entropion, and the risk of postoperative TT with epilation was 1.41 (P = 0.14).
Conclusions:
The study suggests that preoperative epilation may increase the risk of postoperative trichiasis. Further research is needed to confirm the finding.
Translational relevance:
Patients with TT often self-treat, epilating their inturned eyelashes. The World Health Organization recommends surgery to treat TT, but when patients refuse the procedure or mild trichiasis is present, epilation is often recommended. There is some evidence that repetitive or improper epilation can be harmful to the lid and hair follicles. If there is damage to the lid margin, any subsequent surgery could have deleterious outcomes.
Lateinisch pellis, griechisch pelas = die Haut; englisch to peel = to strip off the skin.
Die Dermatologie hat sich seit jeher auch mit der Verbesserung des Hautbildes beschäftigt. Max Joseph (1860–1932), eine der großen Persönlichkeiten der Berliner Dermatologie, brachte bereits 1912 ein „Handbuch der Kosmetik“ [12] heraus, und Ernst Kromayer (1862–1933), einer der Begründer der operativen Dermatologie, verfasste 1913 das Werk „Behandlung kosmetischer Hautleiden“ [14]. Durch die stürmische Entwicklung der wissenschaftlichen und operativen Dermatologie in den letzten 50 Jahren zunächst zurückgedrängt, spielt die ästhetische Medizin in der Dermatologie seit einigen Jahren eine zunehmend große Rolle. Hierzu tragen im Wesentlichen zwei Faktoren bei: Einmal die zunehmend schlechte Vergütung traditioneller ärztlicher Leistungen bei relativ guten Verdienstmöglichkeiten durch privat zu finanzierende ästhetisch-medizinische Leistungen, andererseits liegt das Angebot solcher das Körperbild verbessernder Verfahren ganz im Trend der Zeit.
Die Möglichkeit der Laserbehandlung kutaner Läsionen im Gesichtsbereich führt häufig zu unrealistischer Erwartungshaltung bzw. Wunschdenken der Patienten, mit der Hoffnung auf eine narbenfreie und vollständige Korrektur aller Veränderungen. Diese Behandlungsmodalität hat jedoch auch ihre Limitationen und Gefahren, insbesondere bei technisch falscher Anwendung oder nicht gesicherten bzw. falschen Indikationen. Deshalb ist es wichtig, Möglichkeiten und Grenzen der Laseranwendung auf und in der Haut kritisch darzustellen und mit konventionellen Verfahren zu vergleichen:
Haarwuchsprobleme sind häufig, Betroffene zeigen einen oft hohen Leidensdruck, und die Behandlungsmöglichkeiten sind beschränkt. Vor diesem Hintergrund hat die Bewältigung von Haarproblemen auf den Ebenen des Informationsverhaltens, der Problemlösekompetenz und der medizinischen Therapie zu erfolgen.
Die Nachfrage nach sicherer und effizienter Haarentfernung ist derzeit steigend. Obgleich langfristige Haarentfernung durch die Verwendung von Lasern und nicht kohärenten Lichtquellen demonstriert worden ist, war es wegen des langen Wachstumszyklus bzw. Restzyklus des normalen menschlichen Haarfollikels schwierig, dauerhafte Haarentfernung zu beweisen.
Unerwünschter Haarwuchs ist ein häufiges Problem in der dermatologischen Praxis. Laser- und Lichtsysteme werden seit Jahren zur Entfernung von unerwünschtem Haarwuchs eingesetzt und erfreuen sich ständig wachsender Popularität. Einer zunehmenden Fülle von Geräten und äußerst optimistischen Einschätzungen der Hersteller stehen wachsende Nachfrage und Ansprüche der interessierten Patienten gegenüber. Sowohl für Anwender als auch für Patienten stellt sich die Frage der Effektivität der jeweiligen Geräte. In einer retrospektiven Auswertung der Daten von mehr als 500 Behandlungen an über 300 Patienten sind wir der Frage nach der Wirksamkeit der Behandlung mit einem 800-nm-Diodenlaser (LightSheer) nachgegangen und berichten über Erfahrungen in der Anwendungspraxis.
Infrarotlicht einer Wellenlänge von 1064nm, wie es ein Nd:YAG-Laser emittiert, kann 5-7 mm tief in die Haut eindringen 3. Zwar ist die Absorption des Gewebewassers bei 1064 nm höher als etwa bei den Lasern im sichtbaren Bereich; dies wird jedoch durch die starke Streuung ausgeglichen, die für die Nd:YAG-Laser-Strahlung die oben angegebenen Eindringtiefen ermöglicht 3. Obwohl die Absorption in Melanin bei 1064nm niedriger ist als etwa für Farblichtlaser (532 nm, 694 nm), ist wahrscheinlich die Absorption in Melaninpigment relativ gesehen immer noch deutlich höher als in nicht pigmentierter Haut. Dies ist die Voraussetzung für die selektive Photothermolyse pigmentierter Haarfollikel mit dem Nd:YAG-Laser. Dabei könnten die hohen Eindringtiefen einen weiteren Vorteil darstellen, da Haarfollikel oft einige Millimeter tief in der Haut liegen.
Der menschliche Haarfollikel ist ein komplexes Anhangsgebilde der Haut, das sich aus zahlreichen verschiedenen Zellpopulationen zusammensetzt. Während des Wachstumsprozesses folgt der menschliche Haarfollikel einem charakteristischen, lebenslang sich wiederholenden Wechselspiel zwischen 2–6 Jahre dauernder Wachstumsphase (Anagen), einer in wenigen Wochen ablaufenden Übergangsphase (Katagen) und einer 2–3 Monate anhaltenden Ruhephase (Telogen). Jeder einzelne Haarfollikel durchläuft diese 3 Phasen individuell, sodass das Haarwachstum aller Haarfollikel asynchron verläuft und beim Menschen einem nur noch gering zu bemerkenden Jahreszyklus unterliegt.
Das Gegenteil von trocken ist feucht … und nicht fett. Das Gegenteil von fett ist fettarm … und nicht trocken. Dementsprechend existieren sechs verschiedene Hautzustände (Raab und Kindl, 1999):
1.
Die Normalhaut
2.
Der fett-feuchte Hautzustand
3.
Der fett-trockene Hautzustand
4.
Der fettarm-trockene Hautzustand
5.
Der fettarm-feuchte Hautzustand
6.
Die Mischhaut
Hairs have little biological value in humans. Probably their main function today is as a sensory organ, measuring fine touch. If one simply tries to move an individual hair, the incredible sensitivity of the hair as a sensory organ will be noticed. In many individuals, the scalp hairs protect against sunburn and perhaps provide some insulation. But for the most part, hairs are a cosmetic appendage. The importance of the hairs in a person’s self-image means that for some individuals, minor changes in number, color, texture or distribution cause great personal concern and may lead to a visit to the physician. Hair diseases are often associated with nail diseases as well as widespread skin disorders such as lichen planus or lupus erythematosus. Thus every patient presenting with hair problems should have their nails carefully examined and be offered a complete skin examination. From the physician’s perspective, hair problems are very hard to treat. In addition the hair cycle often lasts many years. Even if one can influence the hair growth or structure, it may take many months before the patient notices any change.
There has long been desire for effective removal of unwanted body hair. Excessive hair in an androgen-dependent distribution, e.g. beard area, lower abdomen in females, is termed hirsutism. Nonandrogen-dependent hair growth, e.g. forearms or back, is termed hypertrichosis. Patients with hirsutism require a full evaluation to exclude treatable causes of androgen excess, including some tumours. Many patients with hirsutism can be managed by oral anti-androgens such as cyproterone acetate.
• Light can destroy hair follicles by photothermal (local heating), mechanical (shockwaves, violent cavitation), and photochemical (generation of toxic mediators) means.
• Different light-based photo-epilation devices are available today (ruby laser, alexandrite, diode laser, Nd:YAG laser, intense pulsed light) based on the use of endogenous chromophores.
• New options include adding exogenous chromophores such as aminolaevulinic acid, carbon suspension, etc.
• Treatment technique, patient selection, actual technique and post-operative considerations have to be carefully planned.
• Expected benefits of photo-epilation must be kept realistic.
• Patients have to be well informed on possible sideeffects and management of complications.
Objective: To show that female pubic hair shaving, a common current practice, is the result of changing trends in dress and fashion, and of the marketing strategies of the manufacturers of hair removal devices; and to consider what women today argue as their reasons for this practice. Materials and methods: The historical background for pubic hair removal is presented, including the approach in other cultures, the frequency and the reasons for this practice at present; the marketing and communication strategies are reviewed. Conclusions: The current female beauty imagery in this early part of the 21st century involves the search for an ideal of smooth hair-free skin which is only achievable through artificial means, leading society as a whole to consider it the standard for cosmetic, hygienic, erotic and self-image reasons.
Lasers for hair removal are a fast-growing area in cosmetic dermatology.
Selective photothermolysis allows for targeting of specific chromophores while minimizing cutaneous damage.
Treatment of individuals should be individualized based on anatomical area, skin and hair color, by varying the wavelength, fluence, pulse duration, spot size, and cooling technique of the laser.
Like with peels - there is nothing like a laser. There ablative lasers and non ablative lasers - all of them requiring special attention. The chapter covers most of them and has a special focus on the newest technology: the fractional technology
Although the loss of scalp hair is distressing and many medical treatments focus on its restoration, the removal of body hair has been adopted since ancient times. Beauty standards, which r eflect the culture of each society, have been presenting the depilated body as absolutely desirable. Through the ages various methods of hair removal have been used depending on the requirements of the individuals. In recent years, Laser and Intense Pulse Light devices have been considered as the most promising solution for excess hair growth, without excluding the efficacy of other methods to induce satisfactory epilatory results. The enzyme-based hair removal method has received little recognition even though experimental and clinical data support its efficacy to provide long term or even permanent epilation. The present review presents these data and examines the likelihood of considering the aforementioned method as ideal.
Der Laser ist heute fester Bestandteil der Dermatotherapie, mit einem breiten Einsatzspektrum für zahlreiche Hautveränderungen. Der erste industriell genutzte Laser wurde im Jahre 1960 entwickelt, während die erste therapeutische Anwendung durch den Dermatologen Goldman im Jahre 1967 erfolgte. Bei richtiger Indikationsstellung und Auswahl des geeigneten Lasertyps gelingt eine maximale Erhaltung gesunden Gewebes mit ästhetisch hervorragenden Ergebnissen.
Androgen excess (AE) is a key feature of polycystic ovary syndrome (PCOS) and results in or contributes to the clinical phenotype of these patients. While AE will contribute to the ovulatory and menstrual dysfunction of these patients the most recognizable sign of AE includes hirsutism, acne and androgenic alopecia or female pattern hair loss (FPHL). Evaluation not includes scoring facial and body terminal hair growth using the modified Ferriman-Gallwey method, but also recording and possibly scoring acne and alopecia. Assessment of biochemical hyperandrogenism is also necessary, particularly in patients with unclear or absent hirsutism, and will include assessing total and free testosterone (T), and possibly DHEAS and androstenedione, although these latter add a limited amount to the diagnosis. Assessment of T requires use of the highest quality assays available, generally radioimmunoassays with extraction and chromatography, or mass spectrometry preceded by liquid or gas chromatography. Management of clinical hyperandrogenism involves primarily either androgen suppression, with a hormonal combination contraceptive, or androgen blockade, as with an androgen receptor blocker or a 5α-reductase inhibitor, or a combination of the above. Medical treatment should be combined with cosmetic treatment including the use of topical eflornithine hydrochloride, and short-term (shaving, chemical depilation, plucking, threading, waxing, and bleaching) and long-term (electrolysis, laser therapy, and intense pulse light therapy) mechanical treatments. Generally acne responds to therapy relatively rapidly, while hirsutism is slower to respond, with improvements observed as early as three months, but generally only after 6 or 8 months of therapy. Finally, FHLP is the slowest to respond to therapy, if it will at all, and it may take 12 to 18 months of therapy before response is begun to be observed.
Der Erfolg von Laser- und IPL-(″intense pulsed light″-)Behandlungen zur Haarentfernung ist von der vorhandenen Melaninmenge im Haarschaft abhängig. Der ideale Patient für die lasergestützte Haarentfernung hat helle Haut mit schwarzen, dicken Haaren. Die Beweislage für die Wirksamkeit der Laser- und Photoepilation ist sehr umfangreich; Anfang 2009 lagen 43 kontrollierte Studien dazu vor. Laserbehandlung und Photoepilation sind den herkömmlichen Methoden wie Rasur, Wachsbehandlung und Elektrolyse überlegen. Wiederholungsbehandlungen verbessern den Wirkungsgrad der Laser- und Photoepilation. Für den Rubin-, Alexandrit- und Diodenlaser sowie den Neodymium:Yttrium-Aluminium-Granat-Laser (Nd:YAG-Laser) und für IPL-Geräte konnte mehrfach eine kurzfristige Wirksamkeit bei der Haarentfernung für einen Zeitraum von bis zu 6 Monaten nachgewiesen werden. Des Weiteren liegen Beweise für eine langfristige Wirksamkeit von Wiederholungsbehandlungen mit Alexandrit- und Diodenlasern sowie langgepulsten Nd:YAG-Lasern vor, die länger als 6 Monate anhielt. Weiße, graue und rote Haare sprechen nicht ausreichend auf Standardbehandlungen an. Eflornithin, topisches Melanin und die photodynamische Therapie können jedoch neue Behandlungsoptionen für diese schwierig zu entfernenden Haartypen darstellen, obwohl es bisher noch an maßgeblicher Evidenz dazu mangelt. Zum jetzigen Zeitpunkt gibt es keine Evidenz für eine vollständige und dauerhafte Haarentfernung. Die Patienten sollten vor der Behandlung mit Laser und IPL über das zu erwartende Ergebnis aufgeklärt werden, um eine realistische Erwartungshaltung zu ermöglichen. Geräte für den Hausgebrauch, die von den Patienten selbst bedient werden können, sind auf dem Vormarsch.
The polycystic ovary syndrome (PCOS) was first coined as a term in 1935 by Stein and Leventhal, who identified a series of patients with the combination of oligo-ovulation and hyperandrogenism [1]. Since that time, diagnosis of this syndrome has undergone multiple iterations of application of diagnostic criteria. Abnormal uterine bleeding was the most common symptom associated with the condition in the late 1800s, but over time, new and better evidence has become available to inform the diagnosis. As recognition of this entity as a complex constellation of symptoms and metabolic derangements expanded, multiple professional groups have attempted to better and more precisely characterize this common syndrome. In the past 25 years, three major sets of diagnostic criteria have emerged to defi ne PCOS (Table 7.1) [2 – 4]. The first set of criteria, outlined at the National Institutes of Health (NIH) in Bethesda, Maryland, in 1990, is the most stringent. It has largely been replaced in clinical practice by the more inclusive Rotterdam criteria. In Rotterdam, The Netherlands, in 2003, a task force sponsored by the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) met to review the available data and to propose a revision of the 1990 NIH diagnostic paradigm. More recently, in 2009, the Androgen Excess Society (AES) outlined its own set of criteria for PCOS. Due to the subtle heterogeneities between the various diagnostic criteria, the reported prevalence of PCOS can vary depending on which definition is used by investigators. The discriminating reader should take note of the specific criteria utilized in the reporting. The NIH meeting in 1990 was the first international conference on PCOS. The information available to attendees at the time was based largely on expert opinion [2].
Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.
In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
Introduction: Due to hormonal stimulation during puberty, changes occur in hair type and distribution. In both sexes, body and facial unwanted hair may have a negative psychological impact on the teenager. There are several available methods of hair removal, but the choice of the most suitable one for each individual can raise doubts. Objective: To review the main methods of hair removal and clarify their indications, advantages and disadvantages. Development: There are several removal methods currently available. Shaving and depilation with chemicals products are temporary methods, that need frequent repetition, because hair removal is next to the cutaneous surface. The epilating methods in which there is full hair extraction include: epilation with wax, thread, tweezers, epilating machines, laser, intense pulsed light, and electrolysis. Conclusions: The age of beginning hair removal and the method choice must be individualized and take into consideration the skin and hair type, location, dermatological and endocrine problems, removal frequency, cost and personal preferences.
Introduction Androgens play an important role in the normal development and functioning of human skin and its accompanying structures. They are necessary for a wide variety of cutaneous processes, ranging from sweat production to hair growth. However, when their careful regulation goes awry, androgens can contribute to the pathogenesis of multiple dermatoses. A deeper understanding of androgens and their impact on human skin allows us to work towards more effective therapeutic options for these skin disorders. Role of androgens in normal human skin. Skin-related androgens The adrenal cortex is largely responsible for synthesizing the circulating hormones dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S). Both the adrenal cortex and the ovaries contribute equally to the production of androstenedione in women [1]. DHEA, DHEA-S, and androstenedione are weak prohormones, which exert their effects after their conversion to their more potent counterparts, testosterone and 5 α-dihydrotestosterone (DHT). In females of reproductive age, androstenedione is secreted by the ovary and adrenal cortex and converted into testosterone in the peripheral organs, including the skin [2] (Figure 8.1). Because of its concentration and potency, testosterone is the main circulating androgen [3]. In both genders, peripheral organs are the main synthesizers of DHT, the most potent tissue androgen produced from the metabolism of testosterone by 5 α-reductases (Figures 8.1 and 8.2) [4]. Although the skin is not the major site of androgen production, the circulating prohormones DHEA and androstenedione can be converted into testoster-one and DHT in sebocytes, sweat glands, and dermal papilla cells [4]. Consequently, these potent androgens can impact dermal functioning. Sweat glands and sebaceous glands account for the vast majority of androgen metabolism in the skin [5]. The peripheral organs produce 100% of the active sex steroids in postmenopausal women [6] (Figure 8.1).
Introduction Aging in men leads to decline in multiple physiologic and psychological parameters. The physical effects of aging broadly recognized include weight gain, loss of muscle mass, and skin changes. The decline is a universal event for men as they age and is due in part to decreasing androgen production. The reduction of serum levels of total, free, and bioavailable testosterone throughout aging has been well documented [1-3]. While the majority of men remain asymptomatic, some complain of symptoms that are attributed to this drop in androgens. The symptoms are oft en vague and nonspecific like depression, loss of energy, and sexual dysfunction. The symptoms secondary to decreased androgen production are so common that some would say that they are not reflective of a medical condition, but rather the normal consequence of aging. Th is perspective may cause clinicians to question the wisdom of androgen replacement therapy in aging men, even in men suffering a significant decrease in quality of life [2]. Occasionally, skeptics of androgen replacement therapy point to the surprising results of the Women’s Health Initiative (WHI) studies to warn of similar, possibly unrecognized risks associated with hormone replacement therapy (HRT) in aging men. One may ask whether such comparison is appropriate. To address this question, a brief review of HRT in women and the WHI studies is necessary [4]. Menopause, women, and hormone replacement therapy Menopause is the permanent cessation of the menstrual cycle. Menopause is tied to a specific date, defined as the day after the final menstrual period, and determined retrospectively once 12 months have gone by with no menstrual flow at all. In the United States, the average age of a woman having her last period, menopause, is 51; however, some women have their last period in their forties, though most have it later in their fifties.
Androgens exert specific effects on the development and function of the female reproductive organs and secondary sexual characteristics and the external genitalia. These include effects on the uterus, vagina, oviduct, preputial gland, clitoris, and the mammary glands [1]. The normal physiology of the female genital tract encompasses complex processes, which are highly dependent on the structural and functional integrity of the genital tissues, involving complex neurovascular mechanisms modulated by numerous local neurotransmitters, vasoactive agents, sex steroid hormones, and growth factors. Regulation of vaginal and clitoral physiology by androgens is an area of great interest, not only in terms of basic understanding of the molecular and cellular bases of vaginal and clitoral function, but also because of clinical implications for use of androgen therapy in women. However, this area of investigation remains, at best, rudimentary and poorly studied. Clinically, testosterone is implicated in maintaining female genital sexual arousal response and sexual desire. Androgens play a key role in maintaining vaginal nerve network fibers and sexual arousal responses and facilitate genital hemodynamics and vaginal lubrication, thus preventing dyspareunia. Androgens in the development and differentiation of female genitalia Sexual development is a function of two processes: sex determination and differentiation. Sex determination is the initial decision to direct the development of the bipotential gonadal ridges into either testes or ovaries [2]. This decision of gonadal sex is governed by genetic sex, and is dependent on the integration of a host of molecular pathways that direct and dictate the development of germ cells and their migration to the urogenital ridge. Determination of whether testes or ovaries will develop is dependent on the presence or absence of the Y chromosome. Sex determination sets the conditions for the un differentiated embryo to develop in a sexually dimorphic manner [3].
Lasers for hair removal are a fast-growing area in cosmetic dermatology. Selective photothermolysis allows for targeting of specific chromophores while minimizing cutaneous damage. Treatment of individuals should be individualized based on anatomical area, skin and hair color, by varying the wavelength, fluence, pulse duration, spot size, and cooling technique of the laser.
Introduction Polycystic ovary syndrome (PCOS) is one of the most common causes of ovulatory dysfunction and identifiable causes of infertility. Clomiphene citrate, aromatase inhibitors such as letrozole, metformin, the combination of metformin and clomiphene citrate, and gonadotropins are the most commonly used medications for ovulation induction in patients with PCOS. The following chapter discusses the background and indications for use of each of these medications. Clomiphene citrate Clomiphene citrate, a selective estrogen receptor modulator, has been used as a first-line medical ovulation induction agent since 1967. Clomiphene citrate is administered for 5 days beginning on any spontaneous or progestin-induced menstrual cycle day from 2 to 5, starting with 50 mg/day and increasing to 150 mg/day if anovulatory. If ovulation cannot be achieved at doses of 150 mg/day, the patient is deemed to have clomiphene citrate resistance. The dose of clomiphene citrate can be increased up to 250 mg. If pregnancy cannot be achieved after six ovulatory cycles, then the patient is deemed a clomiphene citrate failure. Most conceptions occur within the first six ovulatory cycles and at doses of less than 150 mg a day, but the fecundity rate decreases dramatically with age (<4% at >41 years of age) [1 – 3]. Studies with clomiphene citrate have shown an ovulation rate of 60–85% and a pregnancy rate of 30–50% after six ovulatory cycles, with an increased risk of multiple pregnancy of 5–7% [4]. A Cochrane systematic review and meta-analysis of three randomized controlled trials comparing clomiphene citrate with placebo demonstrated that clomiphene citrate improves both ovulation and pregnancy rate [5] The addition of an ovulatory trigger dose of human chorionic gonadotropin (hCG) to clomiphene citrate ovulation induction therapy does not improve ovulation, pregnancy, or miscarriage rates [6]. Aromatase inhibitors Aromatase inhibitors were first proposed as ovulation-inducing drugs in anovulatory women in 2001 [7].
Introduction The less we know about something, the greater the need to constantly redefine it. (P. G. McDonough [1]) Polycystic ovary syndrome (PCOS) affects 6-10% of reproductive age females, making it the most common metabolic endocrine condition in this population [2]. PCOS was first officially described in 1935 by Drs. Stein and Leventhal, resulting in its eponymous name, the Stein-Leventhal syndrome. The syndrome they described were patients who presented with amenorrhea, hirsutism, polycystic-appearing ovaries, and oft en obesity. They described the operation known as a "wedge resection," which was oft en followed by regular menses and sometimes pregnancy. On pathological examination of tissue from the ovarian "wedge resection," they noted multiple subcapsular cysts associated with a thickening of the tunica [3]. Later, this constellation of signs and symptoms became known as PCOS, which reflected the multiple subcapsular follicular cysts. Since 1935, our understanding of this syndrome has expanded and in 2012 an evidence-based methodology workshop was sponsored by the National Institutes of Health. At this workshop one recommendation was to change the name from PCOS to more closely reflect the complex pathophysiology of this condition, which would improve accurate communication and progress in both the clinical and research arenas [4]. Nature vs. nurture PCOS is a complex condition characterized by anovulation and androgen overproduction affecting reproductive age women. Th is phenotype can result in infertility due to ovulatory dysfunction, irregular menses, endometrial hyperplasia, endometrial carcinoma, iron deficiency anemia due to heavy menses, hirsutism, virilization, miscarriage, insulin resistance, glucose intolerance, gestational and type 2 diabetes mellitus, hyperlipidemia, and the potential for increased risk of cardiovascular disease. Other conditions associated with PCOS include obesity, sleep apnea, anxiety, depression, and possible reduction in quality of life. Studies have demonstrated a strong genetic component, supported by family and twin studies, with an important environmental contribution.
Introduction Magnetic resonance imaging (MRI) is an extremely powerful tool for evaluating the adrenal glands. MRI has the unique ability to characterize soft tissues. Th is ability allows for specific pathologic diagnoses to be made in a large number of adrenal lesions. Th is is accomplished without the use of ionizing radiation and, oft entimes, without the need for intravenous contrast material. However, certain lesions may remain indeterminate on MRI findings alone. In these cases, correlation with the overall clinical picture will aid in diagnosis. Rarely, biopsy may be required for definitive diagnosis. MRI utilizes the property of proton nuclear magnetic resonance coupled with robust spatial localization techniques to generate images. Various pulse sequences can be performed in the course of an MRI study. A pulse sequence is a series of radiofrequency electromagnetic wave excitations, magnetic gradients, and resulting radio frequency signals (echoes), which can be arranged in a variety of ways. The arrangement determines which tissue property is emphasized. Pulse sequences can be formulated to highlight certain aspects of the tissues being imaged. For example, the sequence can highlight tissue water content (e.g., T2-weighted) or fat content (e.g., Dixon fat-only images). Lipid detection techniques In fact, fat or lipid detection turns out to be very important in imaging of the adrenal glands. Several lipid-sensitive sequences exist. The two major categories that are utilized in adrenal imaging are chemical shift selective suppression (CHESS) and chemical shift imaging (CSI). Both of these techniques harness the property that water protons and fat protons resonate (precess, spin) at slightly different frequencies (rates) when placed in a strong external magnetic field. This difference in rate of precession is also called the chemical shift. The way these two sequences utilize this property differs such that the resulting images give complementary information. Chemical shift imaging Since there is a precessional (resonance, spin) frequency difference between water and fat protons, only at specific interval periods during nuclear spin precession will a lipid proton and a water proton be in sync, i.e., “in phase.”
Introduction The steady decline of serum androgen levels across the lifespan of an adult woman has been well documented. Comparisons between early reproductive age women and women aged 65-75 show mean total testosterone (T) serum levels decreased by 55% and similar reductions are seen for mean values of free T (49%), dehydroepiandrosterone sulfate (DHEA-S) (77%), and androstenedione (A) (77%) [1]. While ovarian aging and the complete cessation of ovarian estradiol (E 2) synthesis produces the dramatic fall in E 2 levels that defines menopause, there is no evidence that the onset of natural menopause influences androgen levels. Rather, the postmenopausal ovarian hilar and stromal cells continue to respond to luteinizing hormone and secrete androgens. A 15-fold difference for T and a fourfold difference for A were noted between ovarian and peripheral veins in postmenopausal women [2], and in four out of five women a gradient for T still appeared more than 10 years aft er onset of menopause [3]. Additionally, women who underwent surgical menopause with hysterectomy and bilateral oophorectomy had a 40-50% lower serum level of total T and free T than those women with intact ovaries [4]. Other cross-sectional studies have added to the observation that women who had bilateral oophorectomies have significantly lower free T levels [1]. The mechanism of adrenal aging is less well understood, but the age-associated gradual, but marked decline in circulating dehydroepiandrosterone (DHEA) and androgen metabolites has been confirmed by Labrie et al. [5]. DHEA combined with its sulfated conjugate, DHEA-S, is present in the highest amount of all synthesized steroids and is almost totally supplied from the adrenals. While no specific action of its own has been proven, in peripheral tissue DHEA can be converted into active forms of both estrogens and androgens.
A 15‐year‐old girl presented with leg wounds that were sustained after waxing and subsequent chemical depilation. History revealed prior usage of chemical depilatories without irritation. Given this finding, we suspect that waxing disrupted the epidermal barrier and, therefore, rendered the patient more susceptible to severe irritant contact dermatitis upon depilation. While there are reported cases of irritant contact dermatitis and chemical burns secondary to waxing or depilatory cream use in adults, a literature review found no reported cases of chemical burns in a pediatric patient or adult consequent to using these methods in tandem.
Introduction:
There is no satisfactory and efficient method for long-term removal of white-colored and thin hair.
Methods:
We conducted a randomised clinical trial of hirsute patients with excessive white and/or thin hair on the face and/or axilla. In Group I (n: 16), the facial hair on one side of the face was painted with a black eyelash mascara immediately before Nd:YAG laser and the other half was only treated by Nd:YAG. In Group II (n: 20), the axillary hair on one side was painted with the mascara before the Alexandrite laser with the other side being only treated by Alexandrite.
Results:
The terminal hair counts on the painted facial and axillary sides were significantly lower than those on the control sides throughout the study except for the first month. The decrease in the terminal hair count was significant from the beginning of treatment to the second and sixth months on the painted and control facial sides and to the first and sixth months on the axillary sides.
Conclusion:
Hair coloring with black eyelash mascara is a simple, efficient and safe adjunct to Alexandrite and Nd:YAG laser applications to enhance their clinical efficacy in eliminating white and thin facial or axillary hair.
This chapter is a comprehensive review of potential causes of alopecia or hair overgrowth that physicians may see in the paediatric population. It begins with an overview of the embryology and cycling of hair and then reviews the specifics of what is necessary to clinically diagnose a given hair disorder, i.e. the overall physical examination with particular reference to that of the scalp, microscopic evaluation of pulled or plucked hairs, the dermatoscopic examination and how and when to do a scalp biopsy. Hair loss is then addressed with various sections on abnormalities in the initiation of hair growth (examples include ectodermal dysplasias, follicular hyperkeratosis with scalp alopecia, syndromes with hypotrichosis); hair shaft abnormalities, including those presenting with hair breakage (examples include trichorrhexis nodosa, trichothiodystrophy, trichorrhexis invaginata, pili torti, monilethrix, etc.), hair shaft abnormalities associated with unruly hair (examples include uncombable hair syndrome, woolly hair, Marie–Unna type of hereditary hypotrichosis), and miscellaneous hair shaft abnormalities; hair loss due to abnormal cycling (examples include anagen and telogen effluvium, loose anagen syndrome); miniaturization of hair (androgenetic alopecia) and focal scarring and nonscarring causes of alopecia. The chapter then addresses causes of diffuse and local hypertrichosis. In each presentation of a type of hair loss or hypertrichosis, the clinical presentation, potential genetic association (if known) and available treatments are reviewed. Common conditions such as alopecia areata, trichotillomania and scalp infections/infestations are covered in other chapters.
Background: The study's aim is to evaluate the novel "in motion" technique for permanent hair removal using a low level fluence/high repetition rate on patients with a dark skin type over different areas of the body. Objectives: To assess fluence, accumulative energy, and number of treatments needed to achieve a significant hair reduction and patient satisfaction with minimal side effects, low discomfort levels, and high safety profile in a skin type IV-VI Indian patients. Methods: Seventy-one Indian female patients with skin type IV-VI were enrolled in the study. All patients were treated with a low fluence, high repetition rate 810nm diode laser using a predetermined set of parameters for 5 to 6 treatments in 1- to 3-month intervals. hair reduction was measured by patients' satisfaction and all adverse effects were documented. Results: Results obtained a high degree of patient satisfaction and a very low record of adverse events. Treatments were complication-free for dark skins and a reasonable schedule or sessions and intervals. The discomfort during the sessions was negligible.
Literature Review
Physicians frequently recommend electroepilation (electrolysis) in the management of hirsutism, but there have been no English language reports of its clinical effectiveness. We performed over 35,000 hours of electroepilation (electrolysis) on two hundred eighty-one women over a 4-year period. We used conventional, commercially available electroepilation (electrolysis) equipment that produced both thermolysis and blend type currents. We found that electroepilation (electrolysis) helps control hirsutism, and 93% of the patients improved. There was no scarring. For best results electroepilation (electrolysis) must be combined with treatment of excess androgens. Instructions about good grooming and stressing that shaving is not harmful will help to maximize improvement in appearance. Electroepilation (electrolysis) is expensive and not readily available to those lacking insurance or other funding.
This essay is a critique of a revolutionary hypothesis, and of the language used to frame it, that offers a novel interpretation for the dynamics of the follicular cycle by distinguishing, distinctly, germinative cells in the bulge from matrical cells in the bulb. Curiously, this intriguing "bulge-activation hypothesis" elicited practically no response in the scientific literature, and our critique is designed to rectify that.
The new technology of RF‐ID, intelligent tagging, has become widespread in some industries such as distribution and baggage handling, and is set to dominate retail security in the near future. Library security and automation are tailor‐made applications for it which are ready to roll. What is it and what does it mean for Librarians?
From our experience, the most important requirement for permanent epilation by electrocoagulation is not only to destroy hair bulbs, but also to destroy the isthmal regions of hair follicles and the sebaceous glands.
The growth of hair from epilated and non-epilated areas of rats receiving a variety of hormonal treatments was investigated by pulse-labelling with 35S-cystine. While epilation at certain stages of the spontaneous cycle may rephase follicular activity, it did not affect the length, rate or duration of growth of the hairs which erupted subsequently, either in untreated or hormone-treated rats.
Thyroxine shortened the active as well as the resting phase of the follicular cycle. It also increased the growth rate, so that hairs were ultimately the same length as those from untreated animals. Estradiol slightly shortened the duration of the active phase, even though the complete cycle was prolonged. It also decreased the hair growth rate. When administered simultaneously, estradiol and thyroxine exerted their effects independently.
Germinative epidermal cells in the lower end bulb region of anagen hair follicles are highly active, and give rise to hair fibres through rapid proliferation and complex differentiation. They have often been termed hair follicle stem cells, but owing to difficulties in isolation and identification their properties have previously only been clearly documented in vivo. We aimed to isolate and culture germinative cells in vitro, and used microdissection methods to dissect a small but identifiable group of cells from complete follicles. Transmission electron microscopy confirmed that the isolated cells were identical to germinative epidermal cells in situ. SDS-PAGE was used to show that they did not have the same protein composition as epidermis from their immediate proximity (overlying hair matrix), or from other follicular (outer root sheath) and interfollicular (skin basal) regions. Moreover, the germinative cells were found to display morphology and in vitro behaviour that distinguished them from comparative epidermal cells. When cultured in media and on substrata normally conducive to epidermal cell growth they remained in a quiescent state, and did not divide or differentiate. In contrast to other epidermal cells that formed typical pavement-like arrangements, germinative cells remained uniformly small, round and closely packed. However, when cultured in association with hair follicle dermal papilla cells they were radically stimulated into proliferative and aggregative behaviour. Furthermore, they were able to form organotypic-like structures, and exceptionally for skin-derived cell recombinations, a distinct basal lamina at the papilla-germinative cell junction. These results provide evidence that hair follicle germinative cells have intriguing properties that distinguish them from other follicular epidermis. The finding that they can be activated by dermal papilla cells reflects the intimate nature of the papilla-germinative cell relationship in situ, and should facilitate research into hair growth control mechanisms. The nature of germinative cells is discussed in the wider context of hair follicle stem-cell terminology.
Various parameters of hair growth were determined every 28 days for 18 months in 14 healthy Caucasian men aged 18-39 with indoor occupations in Sheffield, U.K. (latitude 53.4 degrees N). In the scalp the proportion of follicles in anagen reached a single peak of over 90% in March, and fell steadily to a trough in September. The number of shed hairs reached a peak around August/September, when least follicles were in anagen. At this time the average loss of hairs was about 60 per day, more than double that during the preceding winter. The rate of growth of the beard was lowest in January and February and increased steadily from March to July to reach a peak about 60% above the winter level. The rate of growth of thigh hair showed a similar pattern though with less pronounced differences. No seasonal fluctuations in finger- or toenail growth were detected.
Women with facial hirsutism are burdened with hairs that often interfere with personal and work activities. Temporary hair removal is a major component in the management of hirsute patients. From a caseload of 1,000 patients, we submitted questionnaires to 271 and interviewed 135. We found that shaving was the most helpful and most frequently used temporary method. Judicious plucking can be helpful if tolerated, but care must be taken to avoid folliculitis, pigmentation, and scarring. Waxing and depilatories were used by less than 6 percent of patients on the face and by about 20 percent on other parts of the body. The avoidance of irritants and the use of hydrocortisone 1 percent cream are important in the management of any irritation due to hair removal techniques. Cosmetic coverups may be helpful.
Inconsistent with the view that hair follicle stem cells reside in the matrix area of the hair bulb, we found that label-retaining cells exist exclusively in the bulge area of the mouse hair follicle. The bulge consists of a subpopulation of outer root sheath cells located in the midportion of the follicle at the arrector pili muscle attachment site. Keratinocytes in the bulge area are relatively undifferentiated ultrastructurally. They are normally slow cycling, but can be stimulated to proliferate transiently by TPA. Located in a well-protected and nourished environment, these cells mark the lower end of the "permanent" portion of the follicle. Our findings, plus a reevaluation of the literature, suggest that follicular stem cells reside in the bulge region, instead of the lower bulb. This new view provides insights into hair cycle control and the possible involvement of hair follicle stem cells in skin carcinogenesis.
Physicians frequently recommend electroepilation (electrolysis) in the management of hirsutism, but there have been no English language reports of its clinical effectiveness. We performed over 35,000 hours of electroepilation (electrolysis) on two hundred eighty-one women over a 4-year period. We used conventional, commercially available electroepilation (electrolysis) equipment that produced both thermolysis and blend type currents. We found that electroepilation (electrolysis) helps control hirsutism, and 93% of the patients improved. There was no scarring. For best results electroepilation (electrolysis) must be combined with treatment of excess androgens. Instructions about good grooming and stressing that shaving is not harmful will help to maximize improvement in appearance. Electroepilation (electrolysis) is expensive and not readily available to those lacking insurance or other funding.
The historical, legal, and theoretical aspects and clinical technics of both electrolysis and thermolysis are critically reviewed. The pitfalls of electronic tweezers and the dangers of self-electrolysis are discussed. Complications of electrolysis and thermolysis and the pathophysiology of hair regrowth are presented. In the United States, the lack of uniform training requirements and standards for electrologists may pose an unrecognized risk to public health. It is suggested that more responsible state legislation be enacted in order to decrease the present potential threat to the public health and safety.
Hair follicle density, and definitive length, root status and rate of growth of hairs were determined for defined areas of the thigh and upper arm in 11 females and nine males aged 20-30 years. Hair follicle density did not differ between males and females. However, on the thigh the definitive length of hair was on average three times greater in males. This was attributable mainly to a longer duration of anagen (X 2 X 46), but also to a greater rate of growth (X 1 X 22). On the upper arm the hair was only 1 X 42 times longer and the duration of anagen only 1 X 27 times greater in males than in females. On the thigh the estimated average duration of anagen was 54 days in males and 22 days in females, with corresponding figures of 151 days and 84 days for the complete cycles. On the upper arms the duration of anagen was 28 days in males and 22 days in females, with corresponding figures of 108 and 106 days for the complete cycle. In females, oral contraceptives had no significant effects on any measurement.
This paper deals mainly with histologic findings and clinical aspects of epilation using insulated needles. Patients were checked for hair regrowth after "thermolysis" epilation--a cycle of three to four treatments at roughly 3-month intervals, within an observation period of 2 1/2 years. The results for 39 patients, compiled 6 months to 1 year after the final epilations, showed almost no or extremely reduced hair regrowth with almost no scarring.
BDF1 male mice were plucked every 3 weeks for 5 months and samples were taken 4 days alter each plucking. After a single plucking, the epidermal labeling index (LI) was about 5 times the unplucked value. This LI decreased after each plucking and was no different from the unplucked value after the seventh plucking. After each treatment the number of follicles with normal growing hairs was less. However. plucking did not destroy the upper piliary canal or the paired sebaceous glands attached to it.
Hair growth from the vertex, temple, mustache, finger, arm and leg of three Japanese men (60, 30, and 21 years of age) was measured by direct observation from October, 1966 to November 1968. Detailed information regarding hair growth cycles in the regions tested is presented.
The histologic changes induced by thermolysis of hairs of the scalp and legs were studied by light microscopy. Two techniques were compared on opposite sides: conventional thermolysis (erroneously termed electrolysis) using bare needles and a newly designed precision epilator using an insulated, bulbous-tipped probe. Thermolysis generally did not immediately eliminate the papilla and hair matrix. Thermal injury provoked an inflammatory reaction which eventually destroyed the hair bulb. The insulated probe produced greater damage to the peribulbar tissue below and less necrosis of the perifollicular dermis above, enhancing the likelihood of permanent epilation and reducing the probability of scarring. The infundibulum and associated sebaceous glands regenerated to near-normal architecture. The lower follicle was replaced by a fibrotic streamer--a scar.
The phototrichogram is a non-invasive technique by which, on the same precise area of the scalp, each individual hair may be identified, and its current growth phase established. This technique was used to study the duration of hair cycles in 10 male subjects, balding and non-balding, by observations at monthly intervals over a period of 8-14 years. The accumulated data served to characterize the effects of ageing in these subjects: a reduction in the duration of hair growth and in the diameter of hair shafts, most evident in the thickest hairs, and a prolongation of the interval separating the loss of a hair in telogen and the emergence of a replacement hair in anagen. These various aspects of ageing of scalp hair contribute to its progressive overall impoverishment. They resemble those observed in the course of male-pattern balding, although their development is less marked.
Isolated human hair follicle germinative epidermal cells were observed in vitro for the first time. When cultured alone, this small, round, novel cell type did not grow, divide, take on an outer root sheath-type appearance, or display any obvious signs of epidermal differentiation. We have previously described comparable cells from rat vibrissa follicles. However, in combination with human hair follicle dermal papilla populations, the germinative epidermal cells were stimulated into proliferative and complex interactive behaviors. This included the formation of composite organotypic structures containing not only impressively intact basement membrane, but also the hair-specific form, glassy membrane.
Telogen effluvium is the result of a perturbation of the hair cycle that is manifest by increased loss of normal club hairs. Although diverse causes for telogen effluvium have been proposed, this article suggests several diverse mechanisms for the first time.
Five different functional types of telogen effluvia are proposed based on changes in different phases of the follicular cycle. These are immediate anagen release, delayed anagen release, short anagen syndrome, immediate telogen release, and delayed telogen release. Diverse causes are confirmed and drug-related telogen effluvia are reviewed.
The five diverse mechanisms proposed for telogen effluvia are generally confirmed and supported by clinical findings.
Most university medical centers do not directly offer electrolysis or thermolysis services to hirsute patients. Little research activity has been focused on these procedures. The successful introduction of a clinical and research electrolysis service into the University of Texas Medical Branch (UTMB) dermatology clinic is described.
The purpose of this communication is to familiarize clinicians with an electrolysis service in a university clinic setting. New advances in permanent hair removal equipment and methods are reviewed.
A description of the UTMB electrolysis clinic is given.
Electrolysis services offered by the UTMB dermatology department have been well received by patients, clinical staff, UTMB faculty, UTMB resident physicians, and private physicians.
This successful medical model for electrolysis services may provide other university dermatology clinics with background information for the development of their own programs. Future research advances in electrolysis and the management of hirsutism may result from this activity.
This essay is a critique of a revolutionary hypothesis, and of the language used to frame it, that offers a novel interpretation for the dynamics of the follicular cycle by distinguishing, distinctly, germinative cells in the bulge from matrical cells in the bulb. Curiously, this intriguing "bulge-activation hypothesis" elicited practically no response in the scientific literature, and our critique is designed to rectify that.
The hair follicle is a cyclic, self renewing epidermal structure which is thought to be controlled by signals from the dermal papilla, a specialized cluster of mesenchymal cells within the dermis. Topical treatments with 17-beta-estradiol to the clipped dorsal skin of mice arrested hair follicles in telogen and produced a profound and prolonged inhibition of hair growth while treatment with the biologically inactive stereoisomer, 17-alpha-estradiol, did not inhibit hair growth. Topical treatments with ICI 182,780, a pure estrogen receptor antagonist, caused the hair follicles to exit telogen and enter anagen, thereby initiating hair growth. Immunohistochemical staining for the estrogen receptor in skin revealed intense and specific staining of the nuclei of the cells of the dermal papilla. The expression of the estrogen receptor in the dermal papilla was hair cycle-dependent with the highest levels of expression associated with the telogen follicle. 17-beta-Estradiol-treated epidermis demonstrated a similar number of 5-bromo-2'-deoxyuridine (BrdUrd) S-phase cells as the control epidermis above telogen follicles; however, the number of BrdUrd S-phase basal cells in the control epidermis varied according to the phase of the cycle of the underlying hair follicles and ranged from 2.6% above telogen follicles to 7.0% above early anagen follicles. These findings indicate an estrogen receptor pathway within the dermal papilla regulates the telogen-anagen follicle transition and suggest that diffusible factors associated with the anagen follicle influence cell proliferation in the epidermis.
Although many temporary treatments exist for hirsutism and hypertrichosis, a practical and permanent hair removal treatment is needed.
Our purpose was to study the use of normal-mode ruby laser pulses (694 nm, 270 microseconds, 6 mm beam diameter) for hair follicle destruction by selective photothermolysis.
Histologically assessed damage in ex vivo black-haired dog skin after the use of different laser fluences was used to design a human study; 13 volunteers with brown or black hair were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2, delivered to both shaved and wax-epilated skin sites. An optical delivery device designed to maximize light delivery to the reticular dermis was used. Hair regrowth was assessed at 1, 3, and 6 months after exposure by counting terminal hairs.
Fluence-dependent selective thermal injury to follicles was observed histologically. There was a significant delay in hair growth in all subjects at all laser-treated sites compared with the unexposed shaven and epilated control sites. At 6 months, there was significant hair loss only in the areas shaved before treatment at the highest fluence. At 6 months, four subjects had less than 50% regrowth, two of whom showed no change between 3 and 6 months. Transient pigmentary changes were observed; there was no scarring.
Selective photothermolysis of hair follicles with the normal-mode ruby laser produces a growth delay consistent with induction of prolonged telogen with apparently permanent hair removal in some cases.
The use of lasers in the treatment of a number of different skin disorders and diseases has become commonplace. This tremendous acceptance by both physicians and patients is a direct reflection of the high degree of precision and selectivity provided by lasers, which helps to minimize the risk of side effects and complications while simultaneously maximizing the opportunity for obtaining a satisfactory outcome. In an attempt to remove unwanted or excess hair, the principles of selective photothermolysis have been employed with several different laser and light devices that permit the effective treatment of large areas of hair-bearing skin with minimal discomfort and with low risk of scarring or other complications. It is possible using current laser technology to permanently remove some hair and induce a prolonged delay in the regrowth of many hairs. With additional experience and an improved understanding of how light can influence the rate and quality of hair growth, it is anticipated that permanent hair removal will be achieved in the near future.
The development of high-peak power or scanned CO2 lasers that precisely remove layers of photodamaged skin has provided a novel method of skin rejuvenation. Clinical data suggest that laser resurfacing provides comparable or better results than conventional methods of chemical peeling and mechanical dermabrasion, with a lower risk-to-benefit ratio. Histologic studies of the effects of these lasers on tissue have been helpful in establishing guidelines for appropriate clinical use of these lasers and insights into the mechanisms whereby facial skin rejuvenation is achieved.
Many individuals seek to decrease facial and body hair density. Although a variety of epilating methods are available, improved techniques would be of interest to patients and physicians alike.
To determine the safety and clinical efficacy of a new laser-based method of hair removal.
A Q-switched Nd:YAG laser was used to scan skin with increased hair after applying a topical carbon-based solution. Thirty-five healthy, adult volunteers were treated with a single treatment to selected facial, neck, and axillary sites.
Twelve weeks after a single treatment, integrated site scores revealed that the majority of patients had over 25% fewer hairs. The 12-week mean percentage of hair reduction, based on anatomic sites, ranged up to 66% and 44% as judged by physicians and subjects, respectively. Adverse events were minimal and temporary.
Topical suspension-assisted Q-switched Nd:YAG laser therapy reduces hair density after a single treatment. Advantages include its speed, technical ease, and minimal adverse effects.
Laser-assisted hair removal with the long pulsed ruby laser is a promising new technique based on selectively targeting melanin in hair follicles.
The purpose of this study was to evaluate the efficacy and safety of the long pulsed ruby laser (EpiTouch) for hair removal.
The Epitouch laser was used for hair removal of the arms of 20 patients. The areas were evaluated immediately post-treatment, and at 1, 4, 8, and 12 weeks, for efficacy and complications.
Postoperative results showed 40-80% regrowth after 12 weeks.
Selective melanin-based photothermolysis with a free running pulsed ruby laser seems to be a promising, noninvasive technique for long-term hair removal. More than one treatment is necessary since only anagen hair will be affected.
The long-term epilation of hair is the goal of several lasers and intense pulsed light systems.
The purpose of the study is to use the EpiLight Hair Removal System to assess long-term epilation and to assess its safety profile following a single treatment session.
Patients received a single treatment with the Epilight Hair Removal System after entering the patient's skin type, skin color, hair color, and hair density into the system's computer software. Treatment parameters include various wavelengths of light, pulse duration, pulse delay, and energy fluence. Thirty-seven subjects received a single treatment using one of four cut-off filters consisting of two to five pulses with energies of 34-55 J/cm2.
The results of a single treatment show hair clearances occurring immediately and over a 12-week study period. Approximately 60% hair removal was noted at 12 weeks.
The EpiLight Hair Removal System is an effective and safe method for long-term epilation of unwanted hair.
To determine the most effective treatment parameters for laser-assisted hair removal using a Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser.
Prospective study to determine the effectiveness of Q-switched ND:YAG laser-assisted hair removal under varying pretreatment protocols. Hair growth was assessed after laser treatment, and the results were compared with those of wax epilation at 4, 12, and 24 weeks.
A private ambulatory laser facility and academic referral center.
Laser-assisted hair removal was performed under 4 different pretreatment conditions. Eighteen areas of unwanted body and facial hair from 12 study subjects were divided into 4 quadrants. Wax epilation followed by application of a carbon-based solution and exposure to Q-switched Nd:YAG laser radiation was performed on 1 quadrant. A second quadrant was wax epilated and exposed to Q-switched Nd:YAG laser radiation without prior carbon solution application. A third quadrant was exposed to laser radiation alone, and a final quadrant was wax epilated to serve as the control. Follow-up evaluations at 1, 3, and 6 months consisted of photographic documentation, manual hair counts, and patient hair-density estimates.
Percentage of hair regrowth as assessed by objective hair counts and patient subjective evaluations.
Mean percentage of hair regrowth at 1 month was 39.9% for the wax-carbon-laser quadrant, 46.7% for the wax-laser quadrant, 66.1% for the laser-alone quadrant, and 77.9% for the wax control quadrant. The percentage of hair regrowth approximately doubled by 3 months but was significantly delayed in all laser-treated quadrants regardless of pretreatment protocol. Full hair regrowth in all anatomic locations was observed by month 6. Patient subjective evaluations of hair density closely approximated hair count data. No adverse effects or long-term complications were observed.
A single hair-removal treatment with the Q-switched Nd:YAG laser is safe and effective in delaying hair growth for up to 3 months. Although the combination of pretreatment wax epilation and topical carbon solution application was effective, laser irradiation alone, with or without wax epilation, also provided a significant delay in hair growth.
Determination of the efficacy of pulsed Alexandrite Laser technology for rapid noninvasive hair removal.
Although previous studies have already shown that Ruby lasers are capable of noninvasive hair removal, a technology for the substantial increase of treatment speed is of great interest.
We have used a 2 msec free running pulsed Alexandrite (lambda = 755 nm) laser operated at a repetition rate of up to 5 pps at energy fluences of 25-40 J/cm2 to treat a wide range of body sites on 126 patients in conjunction with a fiber delivery system and a transparent target ruler. A transparent gel was used as epidermal heat sink. The study lasted 15 months. Pretreatment as well as follow-up hair count per cm2 was performed to determine the level of success. Treatments were repeated when 1-2 mm growth was observed.
The average hair count before the second treatment was found to be close to 65% of the pretreatment count. The average hair count 3 months after the last treatment, was found to be lower than 12%. The interval between treatments ranged from 4 weeks to 3 1/2 months.
The 2 msec pulsed Alexandrite laser technology is effective for the removal of unwanted hairs, ranging from fair to dark, except when hairs are absent in the shaft depending on the stage of their growth cycle. This results in the necessity of a few treatments or touchups. Adverse effects are minimal and transient.
To assess the permanence of hair removal by normal-mode ruby laser treatment.
Hair removal was measured for 2 years after a single treatment with normal-mode ruby laser pulses (694 nm, 270 microseconds, 6-mm beam diameter).
Six test areas on the thighs or backs of 13 volunteers were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2 delivered to both shaved and wax-epilated skin. In addition, there was a shaved and wax-epilated control site. Terminal hairs were manually counted before and after laser exposure. Transient alopecia occurred in all 13 participants after laser exposure, consistent with induction of telogen. Two years after laser exposure, 4 participants still had obvious, significant hair loss at all laser-treated sites compared with the unexposed shaved and wax-epilated control sites. In all 4 participants, there was no significant change in hair counts 6 months, 1 year, and 2 years after laser exposure. Laser-induced alopecia correlated histologically with miniaturized, velluslike hair follicles. No scarring and no permanent pigmentary changes were observed.
Permanent, nonscarring alopecia can be induced by a single treatment with high-fluence ruby laser pulses. Miniaturization of the terminal hair follicles seems to account for this response.
The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
